In January, I wrote about my feelings about my weight, and my history of unhealthy relationships with food and dieting. I concluded the post by saying that I was going to focus not on weighing myself, or dieting, but on choosing real (i.e. not junk, or empty calorie) foods and picking exercise activities that I genuinely enjoyed. That approach worked really well – for about 4 weeks. Then somehow I lost the ability to think kindly towards myself or sensibly about my food choices. I ended up buying a whole new set of clothes for my holiday in a bigger size, and returned from the trip towards the end of March with a renewed Coca-Cola habit and “f*ck it” attitude towards what I ate and drank. Fast forward eight weeks. Now many of the clothes I bought in March no longer fit either. Even my partner, who is usually the soul of tact when it comes to my weight, has made cautious mention of the fact that he’s been looking at photos from previous holidays and can really notice the difference in me. I keep thinking of a cliff-top walk I took with my family at Easter, and how for the first time in my life walking up hills had me puffing and panting, to a degree that I could barely enjoy the view. I also keep thinking of how I try very hard not to see myself naked in the mirror these days, or let my partner see me unclothed. Those are new developments, and not welcome ones.
And so I decided that before yesterday’s visit to the psychiatrist, an appointment that would mark one whole year of treatment, I would have to bite the bullet and weigh myself. Before commencing meds, I had been required to get a range of physical health checks done, including basic bloods, blood pressure, and weight/BMI. So my BMI for May 2011 would be in my clinical notes, ready for comparison. I found myself dithering about, talking about all kinds of other topics before I raised the issue of weight; when you’ve been skirting it for months, it’s hard to address head on. At my request, my psychiatrist called up last year’s BMI. There it was: I have gone up 3 BMI points in 12 months, and am heading towards the borderline of overweight and obese. I know that BMI is not uncontroversial and has flaws, but that’s how the NHS took a baseline last year, so that’s how it got measured this year too.
We talked about the causes. Obviously I know it’s not all about the meds, but there’s no escaping that lithium and quetiapine both have known side effects of weight gain. There’s also the fact that I still feel yanked about by my moods. Feel low/tired/brain fogged? Have some chocolate, have a Coke! Feeling high, tunnel vision about a project? Who wants to stop to eat? Boring! Both of these approaches to eating lead to “focus on the now, worry about the consequences later” approach. The low/tired me will do anything for a quick fix and moment’s pleasure, while the high me will leave eating until my body is desperate for fuel, then eat the first thing comes to hand.
What about exercise? My psychiatrist acknowledged how difficult it can be to physically active when you are feeling heavy, sleepy and demotivated. I am still undergoing a constant upwards creep of the quetiapine dosage, something that’s been going on for about six months now. My symptoms, which are general signs of hypomania such as elation and poor sleep, break through. The dose is then increased, and my symptoms are held in check for a while. The downside of this is that I sleep much longer and feel sedated during the day. Then my symptoms arise again, and the does goes up another 50mg. And so on.
I made it clear that I do know what to do to lose weight. I am not stupid. I understand calories in, calories out. About eight years ago, I lost four stones in weight by following the WeightWatchers online programme. But that was under very different conditions. My mood was completely stable on meds of a kind that did not encourage weight gain. I was single, so did not have to struggle as I do now with a partner who gains little weight and continually brings crisps, chocolate, wine and biscuits into the house. I’m at home all day now; back then walked to and from work and went up and down the office stairs all day. It feels like everything is stacked against me now, and I need help.
So what could the NHS offer? Basically, nothing beyond suggestions I have already considered. Yes, it would help me to make a meal plan for the week and stick to it; but if I feel low or very sleepy, constructing a meal plan will be beyond me; if I feel high, I will consider it a boring annoyance. It’s true, I could ask a friend to exercise with me, however most of my day-time friends are elderly and/or physically disabled, and fitting around my working friends means being at home alone all day, then going in the evening just as my partner comes in. Yes, I could rejoin WeightWatchers. £10.95 per month is not an insignificant sum when on benefits, but is at least nowhere near options such as LighterLife, whose weekly charges would wipe out my entire Employment and Support Allowance payment in one fell swoop. And yes, I suppose I could hang on until I’m more stable, and worry about it later.
So it seems that I have two options. I can try and fight against all these competing drug effects and mood fluctuations and see if I can lose weight now. Or I can wait until the drug effects and mood fluctuations have lessened, although nobody knows how long that will take or how much additional weight I will gain while I’m waiting. Either way, any costs incurred from exercise classes, gym membership, or weight loss programmes will be borne by me. Given my ever increasing risk of conditions such as heart disease, diabetes and hypertension, and the fact that my prescribed medications are a significant factor in why I weigh as much as I do, it would make a lot of sense if the NHS could offer a little more support. I know I am not alone. There are thousands of mental health service users out there who feel that they are struggling with their bodies, as well as their minds.